Provider Demographics
NPI:1730937194
Name:POOLE, SHEKIKA (CPT)
Entity type:Individual
Prefix:
First Name:SHEKIKA
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 CALHOUN STATION PKWY STE C1191
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-5540
Mailing Address - Country:US
Mailing Address - Phone:601-873-3103
Mailing Address - Fax:601-258-7303
Practice Address - Street 1:272 CALHOUN STATION PKWY STE C1191
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-5540
Practice Address - Country:US
Practice Address - Phone:601-873-3103
Practice Address - Fax:601-258-7303
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR5G2C6H7246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy